Current Allergy and Asthma Reports

, Volume 2, Issue 1, pp 67–72 | Cite as

Eosinophilic esophagitis: An emerging clinicopathologic entity

  • Glenn T. Furuta
Article

Abstract

Eosinophilic esophagitis is a clinicopathologic disease characterized by 1) persistent upper intestinal symptoms despite the patient’s use of gastric acid blockade and 2) large numbers of eosinophils in the squamous epithelium of the esophagus. This disease is increasing in frequency and the exact etiologic agent(s) remain elusive. The major importance of identifying eosinophilic esophagitis is that affected patients are receiving fundoplication for persistent symptoms when, in fact, corticosteroids or diet restriction is the treatment of choice.

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References and Recommended Reading

  1. 1.
    Attwood S, Smyrk T, Demeester T, Jones J: Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993, 38:109–116.PubMedCrossRefGoogle Scholar
  2. 2.
    Kelly K, Lazenby A, Rowe P, et al.: Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995, 109:1503–1512.PubMedCrossRefGoogle Scholar
  3. 3.
    Orenstein S, Shalaby T, Lorenzo CD, et al.: The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol 2000, 95:1422–1430. This is the most comprehensive clinical description of eosinophilic esophagitis in children. The authors carefully describe their collective experience and provide their insight into the observed clinical features.PubMedCrossRefGoogle Scholar
  4. 4.
    Walsh S, Antonioli D, Goldman H, et al.: Allergic esophagitis in children-a clinicopathological entity. Am J Surg Pathol 1999, 23:390–396. The authors provide the first detailed description of the histopathologic features of eosinophilic esophagitis.PubMedCrossRefGoogle Scholar
  5. 5.
    Shub MD, Ulshen MH, Hargrove CB, et al.: Esophagitis: a frequent consequence of gastroesophageal reflux in infancy. J Pediatr 1985, 107:881–884.PubMedCrossRefGoogle Scholar
  6. 6.
    Biller JA, Winter HS, Grand RJ, Allred EN: Are endoscopic changes predictive of histologic esophagitis in children? J Pediatr 1983, 103:215–218.PubMedCrossRefGoogle Scholar
  7. 7.
    Siafakas C, Ryan C, Brown M, Miller T: Multiple esophageal rings: an association with eosinophilic esophagitis. Case report and review of the literature. Am J Gastroenterol 2000, 95:1572–1575.PubMedGoogle Scholar
  8. 8.
    Furuta G: Clinicopathologic features of esophagitis in children. Gastroenterol Endoscop Clin North Am 2001, in press.Google Scholar
  9. 9.
    Gupta S, Fitzgerald J, Chong S, et al.: Vertical lines in distal esophageal mucosa (VLEM): a true manifestation of esophagitis in children. Gastrointest Endosc 1997, 45:485–489.PubMedCrossRefGoogle Scholar
  10. 10.
    Lim JR, Gupta SK, Fitzgerald JF, et al.: White specks in esophageal mucosa: a true endoscopic manifestation of severe eosinophilic esophagitis in children? J Pediatr Gastroenterol Nutr 2001, 33:S411.Google Scholar
  11. 11.
    Teitelbaum J, Fox V, Nurko S, et al.: Fluticasone propionate treatment of eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2000, 31:S140.Google Scholar
  12. 12.
    Furuta G, Walsh S, Antonioli DA, et al.: Eosinophil major basic protein deposition occurs in eosinophilic esophagitis. Gastroenterology 1998, 114:G518.Google Scholar
  13. 13.
    Mishra A, Hogan S, Brandt E, Rothenberg M: An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001, 107:83–90. This group has continued to define the murine models of noninfectious gastrointestinal eosinophilia. Here they define a model of antigen-driven eosinophilia and demonstrate its dependence on IL-5.PubMedCrossRefGoogle Scholar
  14. 14.
    Mangano M, Antonioli D, Schnitt S, Wang H: Nature and significance of cells with irregular nuclear contours in esophageal mucosal biopsies. Mod Pathol 1992, 5:191–196.PubMedGoogle Scholar
  15. 15.
    Terris B, Potet F: Structure and role of Langerhan’s cells in the human oesophageal epithelium. Digestion 1995, 56:9–14.PubMedGoogle Scholar
  16. 16.
    Wang H, Mangano M, Antonioli D: Evaluation of T lymphocytes in esophageal mucosal biopsies. Mod Pathol 1994, 7:55–58.PubMedGoogle Scholar
  17. 17.
    Dvorak AM: Ultrastructural evidence for release of major basic protein-containing crystalline cores of eosinophil granules in vivo: cytotoxic potential in Crohn’s disease. J Immunol 1980, 125:460–462.PubMedGoogle Scholar
  18. 18.
    Dvorak AM, Monahan RA, Osage JE, Dickersin GR: Crohn’s disease: transmission electron microscopic studies-immunologic inflammatory response. Alterations of mast cells, basophils, eosinophils, and the microvasculature. Human Pathol 1980, 11:606–619.CrossRefGoogle Scholar
  19. 19.
    Justinich C, Ricci A, Kalafus D, et al.: Activated eosinophils in esophagitis in children: a transmission electron microscopic study. J Pediatr Gastroenterol Nutr 1997, 25:194–198.PubMedCrossRefGoogle Scholar
  20. 20.
    Kephart GM, McGovern TW, Carpenter HA, Gleich GJ: Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterology 1992, 102:137.Google Scholar
  21. 21.
    Lavo B, Knutson L, Loof L, et al.: Challenge with gliadin induces eosinophil and mast cell activation in the jejunum of patients with celiac disease. Am J Med 1989, 87:655–660.PubMedCrossRefGoogle Scholar
  22. 22.
    Levy AM, Gleich GJ, Sandborn WJ, et al.: Increased eosinophil granule proteins in gut lavage fluid from patients with inflammatory bowel disease. Mayo Clin Proc 1997, 72:117–123.PubMedCrossRefGoogle Scholar
  23. 23.
    Makiyama K, Kanzaki S, Yamasaki K, et al.: Activation of eosinophils in the pathophysiology of ulcerative colitis. J Gastroenterol 1995, 30:64–69.PubMedGoogle Scholar
  24. 24.
    Rabb Y, Fredens K, Gerdin B, Hallgren R: Eosinophil activation in ulcerative colitis: studies on mucosal release and localization of eosinophil granule constituents. Dig Dis Sci 1998, 43:1061–1070.CrossRefGoogle Scholar
  25. 25.
    Talley NJ, Kephart GM, McGovern TW, et al.: Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterology 1992, 102:137–145.Google Scholar
  26. 26.
    Torpier G, Colombel JF, Mathieu-Chandelier C, et al.: Eosinophilic gastroenteritis: ultrastructural evidence for a selective release of eosinophil major basic protein. Clin Exp Immunol 1988, 74:404–408.PubMedGoogle Scholar
  27. 27.
    Flavahan NA, Slifman NR, Gleich GJ, Vanhoutte PM: Human eosinophil major basic protein causes hyperactivity of respiratory smooth muscle. Role of the epithelium. Am Rev Respir Dis 1988, 138:685–688.PubMedGoogle Scholar
  28. 28.
    Furuta GT, Ackerman SJ, Lu L, et al.: Stem cell factor influences mast cell mediator release in response to eosinophil derived granule major basic protein. Blood 1998, 92:1055–1061.PubMedGoogle Scholar
  29. 29.
    Furuta G, Ackerman SJ, Varga J, et al.: Eosinophil granulederived major basic protein induces IL-8 expression in human intestinal myofibroblasts. Clin Exp Immunol 2000, 122:35–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Haskell MD, Moy JN, Gleich GJ, Thomas LL: Analysis of signaling events associated with activation of neutrophil superoxide anion production by eosinophil granule major basic protein. Blood 1995, 86:4627–4637.PubMedGoogle Scholar
  31. 31.
    Kita H, Abu-Ghazaleh RI, Sur S, Gleich GJ: Eosinophil major basic protein induces degranulation and IL-8 production by human eosinophils. J Immunol 1995, 154:4749–4758.PubMedGoogle Scholar
  32. 32.
    Rochester CL, Ackerman SJ, Zheng T, Elias JA: Eosinophil-fibroblast interactions: granule major basic protein interacts with IL-1 and transforming growth factor-b in the stimulation of lung fibroblasts IL-6-type cytokine production. J Immunol 1996, 156:4449–4456.PubMedGoogle Scholar
  33. 33.
    Thomas LL, Zheutlin LM, Gleich GJ: Pharmacological control of human basophil histamine release stimulated by eosinophil granule major basic protein. Immunology 1989, 66:611–615.PubMedGoogle Scholar
  34. 34.
    Uchida DA, Ackerman SJ, Coyle AJ, et al.: The effect of human eosinophil granule major basic protein on airway responsiveness in the rat in vivo. Am Rev Respir Dis 1993, 147:982–988.PubMedGoogle Scholar
  35. 35.
    White SR, Ohno S, Munoz NM, et al.: Epithelium-dependent contraction of airway smooth muscle caused by eosinophil MBP. Am J Physiol Lung Cell Mol Physiol 1990, 259:L294–303.Google Scholar
  36. 36.
    Zheutlin LM, Ackerman SJ, Gleich GJ: Stimulation of basophil and rat mast cell histamine release by eosinophil granulederived cationic proteins. J Immunol 1984, 133:2180–2185.PubMedGoogle Scholar
  37. 37.
    Hogan S, Mishra A, Brandt E, et al.: A critical role for eotaxin in experimental oral antigen-induced eosinophilic gastrointestinal allergy. Proc Natl Acad Sci U S A 2000, 97:6681–6686.PubMedCrossRefGoogle Scholar
  38. 38.
    Liacouras C, Wenner W, Brown K, Ruchelli E: Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr 1998, 26:380–385.PubMedCrossRefGoogle Scholar
  39. 39.
    Faubion W, Perrault J, Burgart L, et al.: Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr 1998, 27:90–93. These investigators demonstrated the impact of the novel use of swallowed, not inhaled, metered dose units of fluticasone propionate and betamethasone in the treatment of eosinophilic esophagitis.PubMedCrossRefGoogle Scholar
  40. 40.
    Neustrom M, Friesen C: Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol 1999, 104:506.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Glenn T. Furuta
    • 1
  1. 1.Combined Program in Pediatric Gastroenterology and NutritionChildren’s Hospital Boston, Harvard Medical SchoolBostonUSA

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